Leading the Way on Health Care

It’s just
the type of program the Obama administration should have wanted to hear about during yesterday’s health-care
forum in Los Angeles, because it’s a great example of innovative ways to
meet health-care needs.

The
nationally accredited family medicine residency sees 230,000 patients a year through a public-private
partnership. It trains 27 physicians a year, many of whom remain in an
under-served county with a 16 percent unemployment rate and 20 percent of its
people on Medi-Cal. Graduates of the program have a 100 percent success
rate in passing board exams on the first try. Most of the doctors – 75 percent
– remain in California
after they’re trained.

It’s too
bad the federal government on one hand refuses to admit the program exists but
on the other wants a California
county and a private hospital to repay millions of dollars in funding the feds
contributed over almost a dozen years.

Confused?
So are officials in Stanislaus
County, where the board
of supervisors reluctantly voted recently to pay $11.1 million
to keep its medical residency program going through June 2010.

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“They’re
telling us it’s an excellent program and that they have no problem with it
continuing,” County Director of Legislative Affairs David T. Jones said.
“They’re just not going to fund it.”

“They”
would be the Centers for Medicare and Medicaid Services in the Department of
Health and Human Services.

The agency long had funded the residency program,
continuing the contributions after it became a joint venture between the county
and Tenet Healthcare’s Doctors
Medical Center
when the county closed its hospital in 1997 and contracted with Doctors for
indigent care.

The
residency program, which has existed in one form or another since 1935
and currently is academically accredited through the University
of California at Davis, involved out-patient training at
county-run clinics and in-patient training at Doctors.

The feds
had no problem with that until last summer, when officials decided that the
county should have officially closed the old residency program and created a
new one in 1997. CMS declared that the program had not existed since 1997 and
told the county and Doctors to pay back $19.1 million.

County
officials asked a CMS official to point to federal regulations requiring that.
“We were told, ‘You’re not going to find it in the regs. It’s all in my
head, but it’s not inconsistent with the federal regs,’ ” Jones said.

So the
county went back to work, hastily drawing up a new program that expanded the
private partnership to two other hospitals in the county. Officials could have it
ready to roll by 2010, Jones said.

“CMS
loved that model,” Jones said. “But they told us we had to shut down
everything for one year. Fire all the faculty and start over.”

So on one
hand, the feds say the program doesn’t exist and demands that $19.1 million be
repaid. But on the other, they say the county has to shut down the program it
doesn’t acknowledge before it can start a new one.

“We’re
dealing with a rogue agency here,” Jones said.

Even
though the county already was facing a $35 million budget gap, it has no choice
but to come up with the $11 million to keep the program going, Jones said. If
the residency ended, 30 family-care physicians who form its faculty would have
left the county. “And where would those 230,000 patients have gone?”
Jones asked.

The
county plans to again ask CMS to reconsider, and it has the support of groups
statewide.

“President
Obama has made primary care and prevention the centerpiece of his health reform
plan,” the California Medical Association wrote in a letter to CMS.
“To achieve these goals, we will need family physician residency training
programs like the crucial one in Stanislaus
County. Preservation of
this quality family medicine physician training program is consistent with the
president’s national health care goals.”